Intake Overview Flashcards
where does 80% of the initial exam info come from
the interview
where does the other 20% of initial exam info come from
systems review and tests/measures
what is the initial goal of a hx
is the primary c/o NMS or medical?
- risk and sx screening can r/o or r/i medical vs NMS
what are the methods for info gathering
chart review
interdisciplinary discussion
patient interview
questionnaire/survey
what info might a questionnaire be best for (5)
risk factors
general health - review of systems
meds
surgical hx
medical tests - XR, MRI, EMG, blood work
what settings are questionnaires really common in
outpatient
- direct access setting
what info is better gathered verbally
HPI
- ask follow up questions
why might hobbies included on an intake form
help find out normal activity level and helps w goal writing
what are general risk factors (7)
age
sex at birth
BMI
smoking
occupation/hobbies
ethnicity
substance abuse
what age ranges are risk factors
> 65yo “aging adult”
- for dz and comorbidity, med interactions
0-3 - inc risk for peds problems
13-20 teens
what about the female sex at birth might be risk factors for
if of childbearing age
gynecological issues
BMI, smoking, alcohol, and drugs are inc health risk; what type of prevention is this an opportunity for you to implement
health promotion education
what is construction work a risk factor for
asbestos exposure»_space; pulm issues
what is some health care professions a risk factor for
radiation exposure
what is a dentist occupation a risk factor for
higher risk for depression
what is sedentary lifestyle a risk factor for
CV risk
how is a Native American ethnicity a risk factor for health outcomes
higher prevalence of DM2
what does being an African American man inc the risk of
heart dz (essential HTN)
what does being an African American woman inc the risk of vs. a white woman
2.5x higher incidence
2x mortality
what does an African American ethnicity inc the likelihood of dying from
pneumonia
influenza
DM
liver dz
what are the social determinants of health (SDH)
education (access and quality)
health care (access and quality)
economic stability
neighborhood/built environment
social/community context
if screening for SDH, what is an important thing to have ready
the resources to help them
what is important in the process of implementing SDH
to implement it across the board w everyone
- can’t pick and choose
what substance use/abuse are risk factors
caffeine
tobacco (all forms)
alcohol
what does the use and abuse of tobacco and caffeine specifically inc the risk of
inc bp of HTN adults by ~15/33 mmHg for up to 2hrs after ingestion
- can be dangerous if pt is HTN
what are the PT implications for someone who uses/abuses tobacco and/or caffeine and has HTN
careful monitoring of VS during exercise
important to know when last consumed
what conditions do you see teens and adults self medicating for with alcohol
ADD/ADHD
PTSD
alcohol or drug abuse is a very common cause of what condition
TBIs
what is the alcoholism criteria
men: >14 drinks per week
women: >7 drinks per week
what body systems which alcohol affects is of particular interest to PTs
neurologic
musculoskeletal
what are 5 common neurologic/MS system issues d/t alcohol that PTs may treat
alcoholic polyneuropathy
alcoholic myopathy
alcoholic ataxia (cerebellar)
nontraumatic hip osteonecrosis
injuries from falls
how does alcoholic polyneuropathy present
bilateral numbness/tingling in sock/glove distribution
how could alcoholic ataxia be a cerebellar issue
d/t cerebellar deterioration from chronic alcohol use
why is nontraumatic hip osteonecrosis seen in cases of alcohol abuse
osteonecrosis caused by a loss of blood supply due to the alcohol abuse
4 alcohol screening questions
how do you interpret the responses
- have you had any fx or dislocations to your bones or joints?
- have you been injured in road traffic accident?
- have you ever injured your head?
- have you been in a fight or been hit/punched in the last 6mo?
if yes to 2 or more, red flag for alcohol abuse
what are the 4 intake form categories
general health screening
medical screening
current sx
functional outcome measures & screening
what are the top 6 common dx found in medical screening
cancer
spinal infection
cauda equina
AAA (abdominal aortic aneurysm)
vertebral fx
depression/suicide risk
what body systems are evaluated in medical screen (8)
cardio
pulm
GI
hepatic
biliary
renal
urinary
reproductive
what 2 tools are frequently utilized to measure current sx
body chart - where does it hurt
NPRS (numeral pain rating scale)
when going through questionnaires of sx what are you looking for for effective med screening that might lead to a dx
system clusters
why is it important to ask about if the pt has ever been dx with any conditions in the past
previous conditions:
- can inc susceptibility
- could be coming back
- could be presenting in a different way
when are we a mandated reporter of physical abuse
children (0-18yo)
aging adult / elder abuse
when are mandated to report physical abuse in children
“reasonable suspicion of a problem”
what can we do for physical abuse in adults since we aren’t mandated to report?
health promotion and safety
ethically bound to inquire and refer
what is a good question to start w to screen for physical abuse / assault
do you feel safe at home?
what do you often see clustered w pts experiencing chronic pain
> 50% report physical and/or sexual abuse hx (both men and women)
daily HA associated
hx of many injuries and accidents
- including multiple MVAs
what are the PT implications for a pt w a hx of abuse
PT has a lot of hands on techniques that might be triggering
- INFORMED CONSENT
watch for non verbal responses
- ms guarding
frequent check ins
what are the most common SE for meds
constipation/diarrhea
nausea
abdominal pain
sedation
what are 4 general things to screen for if pt is on medications
ADE - unpredictable, dangerous
drug to drug interaction
drug to dz interaction
SE - predictable, undesirable
what are you watching for w common OTCs (ie NSAIDs) used for pain control
4 D’s
Dizziness
Drowsiness
Depression
visual Disturbance
what is s/sx of antibiotics
skin reactions (ie rashes)
joint pain
what is a s/sx of diuretics
ms weakness/cramping
what is a s/sx of caffeine
ms hyperactivity
what is a s/sx of corticosteroids
hip pain d/t femoral head necrosis
what is a common s/sx of thorazine/tranquilizers and antipsychotics
gait disturbances
what is the acceptable dosage for OTC NSAIDs
1200mg max
- prescribed doses for something like RA might be higher than this
what pt population might be taking NSAIDs
back, shoulder, scap pain
for pts taking NSAIDs what should you look for and how do you use this info
look for GI complications
- correlate inc sx after taking meds, food intake
what pt population is at special risk with NSAIDs
post-surgical
what are post-surgical pts on NSAIDs at risk for
hypotension
GI bleed
dec bone and tendon healing
what is a pain management med you could recommend to post-surgical patients
tylenol
what do sx do you report if noticed in a pt taking NSAIDs
inc bp
ankle/foot edema
what would inc bp in a pt taking NSAIDs indicate
renal vasoconstriction
what are risk factors for GI complications in pts taking NSAIDs
> 65yo - confusion/memory loss
hx of peptic ulcer dz
smoking, alcohol use
what is a pro to the use of acetaminophen when managing pain
less GI issues
what is the max dosage for acetaminophen
4000mg for every 24hrs
what is a name brand for acetaminophen
tylenol
what is a potential side effect of acetaminophen usage
liver toxicity
what inc the risk of liver toxicity in pts taking acetaminophen
alcohol and vitamin C intake
what are the 3 types of corticosteroids
anabolic
mineralocorticoid
glucocorticoid
what types of corticosteroids are most commonly seen
mineralocorticoid
glucocorticoid
what are examples of anabolic corticosteroids
testosterone
estrogen
progesterone
what is a potential side effect of anabolic corticosteroid usage
roid rage
- usually seen in illegal usage
what are mineralocorticoids taken for
electrolyte balance
what are glucocorticoids taken for
anti-inflammatory
what are potential side effects of glucocorticoids (4)
GI issues
AVN of the hip
immunosuppression
psychological issues
what is the dosage like for corticosteroids
start at higher dose and then have tapering off dose
why is the dosage of corticosteroids an important pt education piece
pt shouldn’t stop suddenly taking them
- can have withdrawal bc body needs time to start producing its natural corticosteroids again
what are s/sx of corticosteroid withdrawal (7)
severe fatigue
weakness
body aches
joint pain
nausea
loss of appetite
light headedness
what does hormone therapy put pts at an inc risk for
HTN
clotting issues (ie DVTs)
what are risk factors for DVTS in pts receiving hormone therapy (6)
> 35yo
smoker
HTN
obesity
DM
recent surgery
what does injectable hormone therapy (depro-provera) put pt at inc risk for
bone loss
what are 4 common examples of opioids
codeine
morphine
oxycodone
hydrocodone
what are side effects of opioids (6)
nausea
constipation
dry mouth
itchy skin
DROWSINESS
DIZZINESS
what is an important side effect of opioids w direct PT implications
dec central respiratory drive and rate
- inc airway resistance
- dec ventilation
what are risk factors for opioid abuse
<65yo
previous hx of abuse
depression and psychotropic med use
what is an important thing to follow up if pt is on opioids
how long has pt been on them
why might pt experience joint pain while on antibiotics
noninflammatory
how long can SE of antibiotics last? what is the PT implication of this?
SE can occur 2 hrs to 60 days after taking meds
implication - hx of taking antibiotics is important bc SE can last up to 60 days
what are fluoroquinolones (cipro, levaquin) typically used to treat
antibiotics
UTI and URI treatment
what do fluoroquinolones put pt at inc risk for
possible tendonitis and/or tendon rupture
what risk factors inc the risk of toxicity while taking fluoroquinolones
if taken w corticosteroids and >60yo
what are some examples of natraceuticals (8)
herbs
vitamins
minerals
antioxidants
supplements
fish oil
melatonin
fat vs water soluble vitamins
what is an important consideration regarding natraceuticals when getting a med hx
need to ask specifically
- patients prob won’t consider these meds
what patient population is at special risk for SE from natraceuticals
post op
what is a characteristic of natraceuticals to be wary of when reviewing meds
can see significant interactions w other meds
what SE of natraceuticals can you see in post op patients (5)
anticoagulation
HTN
CV function changes
sedation
diuresis
what should be included in your questions when getting a surgical hx (3)
comprehensive list of surgeries/procedures
dates
scars
what can a list of medical tests provide insight into
medical direction of the case
what are 5 ex of medical tests
XR
MRI
CT
EMG
blood work
what does a body chart vs NPRS tell you
body chart - location and type of pain
nprs - how high is the pain
what is an important follow up question to a patient reporting a hx of pain
what has worked
what hasn’t worked
what are the 6 patterns of pain
vascular
neurogenic
musculoskeletal (somatic)
neuropathic
emotional
visceral
descriptors of vascular pain
cramping
temp changes (hot or cold)
throbbing
descriptors of neurogenic pain
shooting
lancinating/stabbing
superficial in a dermatomal pattern
descriptors of musculoskeletal (somatic) pain
deep
sharp
ache
descriptors of neuropathic pain
hyperalgesia
allodynia
central sensitization
hyperalgesia vs allodynia
hyperalgesia = inc sensitivity to pain
allodynia = pain from stimulus that normally doesn’t cause pain
what is the etiology of neuropathic pain
change in central processing of pain and how brain is interpretting it
- can have emotional impact on better or worse pain
what is the definition of an emotional pattern of pain
SYMPTOM MAGNIFICATION
self-destructive, socially reinforced behavioral response pattern consisting of reports or displays of sx which control the life of the sufferer
how does a pt talk ab their pain that would tip you off to being possibly an emotional pattern
sx rather than physiologic phenomenon of injury determine the outcome/function
- ex: my back won’t let me ….
what are characteristics of a visceral pain pattern
constant
intense (won’t change much)
unrelieved by rest or position change
doesn’t fit expected mechanical or NM pattern
what are the 3 types of visceral pain patterns
gradual
progressive
cyclical
pt descriptors of visceral pain
colicky
knifelike
boring
deep aching
what are visceral pain indicators that PTs could identify through tests
can’t alter, provoke, alleviate, eliminate, aggravate sx
doesn’t fit expected pattern
PT intervention doesn’t change clinical picture or pt gets worse
what are red flags in general (4)
sx out of proportion to injury
sx persist beyond expected time frame
no position is comfortable
unable to mechanical provoke or relieve
what is a medical history (in the most general of terms) and where in the intake do you get this
what they told you
- in hx duh
where do you get associated s/sx and where is this categorized in the intake
what you asked ab
- hx
how do you determine the clinical presentation and where does this go in an intake
what you saw
- tests and measures
